USRN Utilization Review Nurse

5 days ago

Taguig, National Capital Region, Philippines Shearwater Health Full time

Let your Passion Lead You at the Home of Clinicians with over 5000+ employees who have trusted us with their careers

Physical Sites: Taguig, Cebu, and Pampanga

Our Clinicians & Associates advocates for better patient care while enjoying these benefits:

  • PHP100,000 Sign-On Bonus (for selected accounts)
  • Work from home until further notice (for selected accounts)
  • HMO on Day 1 with 2 Dependents upon regularization.
  • Group Life Insurance
  • Highly Competitive Salary
  • Complexity Allowance
  • Annual Salary Increase
  • Quarterly Performance Bonus
  • Service Incentive Leave (SIL) with Leave Conversion
  • Work-Life Integration
  • Get Visa Sponsorship & Work Abroad (*)

    *Terms and Conditions Apply

The USRN Utilization Management Nurse role is responsible in performing medical necessity review of proposed prospective, concurrent, and retrospective cases such as medical treatments, auto-injury related request, hospitalization, home care, and inpatient/outpatient treatment plans for medical necessity and efficiently in accordance with the client's-specific contract rules and guidelines and with company's policies, practices and procedures to facilitate quality and cost effective care for the injured employee. Summarize clinical documents, provide guidelines, draft medical necessity determinations, requests additional clinical information if required.

What we look for:

  • Must have an active US Nursing License
  • Must be a valid Philippines passport holder
  • With at least one (1) year of recent hospital bedside care experience
  • Experience in Utilization Management, Coding, Back office, and other CPO related processes is a must
  • Knowledgeable in Medical/Clinical Summary Writing
  • With excellent Communication, Organizational, Time Management, and Interpersonal skills
  • Must be amenable for a graveyard shift or any shift schedule
  • Must be amenable to report onsite (Taguig/Pampanga/Cebu)

Note: Only USRN profiles with Utilization Management/Review experience will be shortlisted.

  • USRN- Nurse Trainer

    1 week ago

    Taguig, National Capital Region, Philippines Tata Consultancy Services Full time

    Job Summary: We are seeking a dynamic and experiencedClinical Nurse Trainer (USRN)to lead onboarding, skills development, and ongoing training for registered nurses supporting telephonic triage, utilization management, prior authorization, and administrative clinical support functions. The ideal candidate will combine clinical knowledge, adult learning...

  • Utilization Review Nurse Team Leader

    3 days ago

    Taguig, National Capital Region, Philippines Access Healthcare Services Manila, Inc. Full time

    About the role As the Utilization Review Nurse Team Leader at Access Healthcare Services Manila, Inc.', you will play a pivotal role in leading and mentoring a team of Utilization Review Nurses. Based in the heart of Taguig City, Metro Manila, this full-time position offers opportunities for career growth and development within a dynamic healthcare...

  • USRN PTP

    3 days ago

    Taguig, National Capital Region, Philippines TASQ Staffing Solutions Full time

    Work Setup: Onsite (Taguig)TARGET SD: FEB 5, 2026REQUIREMENTS:College Graduate of BS NursingActive PHRN & USRNBachelor of Science in Nursing with active US license in at least one US stateAt least 1-3 years of acute, hospital-based clinical experience in a medical/surgical unit, emergency department, and/or ICU JOB HIGHLIGHTWriting client-facing clinical...

  • Philippines and/or USRN QA Specialist/ Team Lead

    1 week ago

    Taguig, National Capital Region, Philippines Nityo Infotech Full time

    USRN QA SpecialistWith at least 1-2 years of Utilization Management experience ; must have no Priority DateLicense: USRNHighly prefer - no ongoing US applicationAt least 6 months of related clinical work experienceThe Quality Assurance (QA) Specialist is responsible in ensuring accuracy of information and quality of delivery by monitoring, auditing,...

  • USRN NCLEX Academy Sponsorship Program

    5 days ago

    Taguig, National Capital Region, Philippines Shearwater Health Full time

    Let your Passion Lead You at the Home of Clinicians with over 5000+ employees who have trusted us with their careersPhysical Sites: Taguig, Pampanga, and CebuOur Clinicians & Associates advocates for better patient care while enjoying these benefits:Temporary Work from Home during review period*All expense-paid NCLEX Scholarship*Guaranteed USRN account...

  • NCLEX Training Program Nurse Associate

    1 week ago

    Taguig, National Capital Region, Philippines Stark Asia Solutions, Inc Full time

    Work Setup: Onsite | Taguig City – Alliance Global TowerLine of Business: NCLEX AcademyTarget Start Date: December 18, 2025Schedule: ShiftingSalary Structure₱24,791 – Basic Salary₱1,500 – Transportation Allowance₱2,800 –_ Non-Taxable Monthly Allowance_Position OverviewJoin the NCLEX Academy as a PHRN / Nurse Trainee, where you will undergo...

  • Utilization & Denials Management Supervisor

    3 days ago

    Taguig, National Capital Region, Philippines MicroSourcing Full time

    Discover your 100% YOU with MicroSourcingPosition:Utilization & Denials Management SupervisorLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and...

  • Utilization & Denials Management Supervisor

    3 days ago

    Taguig, National Capital Region, Philippines MicroSourcing Full time

    Discover your 100% YOU with MicroSourcingPosition: Utilization & Denials Management SupervisorLocation: TaguigWork setup & shift: Onsite | Night shift Why join MicroSourcing?You'll have:Competitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance,...

  • Associate BPM Lead

    2 weeks ago

    Taguig, National Capital Region, Philippines UST Full time

    Role DescriptionAs an Appeals and Grievances USRN, one must be able to effectively and efficiently process the transactions assigned in a timely manner, clarify complex transactions as needed and ensure that quality of output and accuracy of information is maintained, in accordance to SLAs.Investigate and process complex grievances and appeals requests from...

  • Utilization and Denials Management Auditor

    3 days ago

    Taguig, National Capital Region, Philippines MicroSourcing Full time

    Discover your 100% YOU with MicroSourcingPosition:Utilization and Denials Management AuditorLocation:TaguigWork setup & shift:Onsite | Night shiftWhy join MicroSourcing?You'll HaveCompetitive Rewards: Enjoy above-market compensation, healthcare coverage on day one, plus one or more dependents, paid time-off with cash conversion, group life insurance, and...